32: Postanesthetic Care

CHAPTER 32 Postanesthetic Care






3 Describe the process for postanesthetic care unit admission


A report is given by the anesthesia caregiver to the PACU nurse, reviewing the patient’s prior health status, surgical procedure, intraoperative events, agents used, and anesthetic course. The use of muscle relaxants and reversal of neuromuscular blockade, the intraoperative interventions for analgesia, and the intraoperative fluids and blood products received guide in planning PACU care. Initial assessment of the patient by the PACU nurse includes vital signs, baseline responsiveness, adequacy of ventilation, and adequacy of analgesia. Various scoring systems have been used to allow numeric scoring of subjective observations as an indicator of progress toward discharge. The Aldrete scoring system (Table 32-1) tracks five observations: activity, respiratory effort, circulation, consciousness, and oxygenation. Scales for each are 0 to 2, and a total score of 8 to 10 indicates readiness to move to the next phase of care. Regression of motor block in the case of regional anesthesia is also an important determinant of readiness for discharge.


TABLE 32-1 The Aldrete Score























Activity





Respiration





Circulation





Consciousness





O2 saturation






BP, Blood pressure.


Adapted from Aldrete AJ, Krovlik D: The postanesthetic recovery score, Anesth Analg 49:924–933, 1970.





6 How is ventilation adversely affected by anesthesia?


Residual neuromuscular blockade, opioid effects, and lingering effects of inhalational anesthesia can result in postoperative hypoventilation (Table 32-2).


TABLE 32-2 Ventilation Problems in the Postanesthetic Care Unit





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May 31, 2016 | Posted by in ANESTHESIA | Comments Off on 32: Postanesthetic Care
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